"This Is Not the Original Timeline": A Case Report of an Extended Dissociative Episode in a Healthy Young Male Accompanied with Severe Decline in Mental State.

Dissociation is a disconnection between a person's thoughts, memories, feelings, actions, or sense of who he or she is. Dissociative disorders can be described and understood using the combination of five core symptoms: amnesia, depersonalisation, derealisation, identity confusion, or identity alteration. They are frequently associated with previous experience of trauma. The challenge in diagnosis and the lifetime prevalence of approximately 10% in the general population and clinical psychiatric setting ensures the relevance of this case. We write about a 21-year-old gentleman with history of autism and obsessive compulsive disorder, but no significant medical history was presented to the emergency department with increased anxiety, subsequently progressing to agitation, pacing, and becoming nonverbal. No significant findings were uncovered on laboratory blood testing (other than prolactin 737 mu/L and phosphate 0.35 mmol/L), lumbar puncture, or brain imaging. Consequently, he was admitted to a psychiatric unit for assessment. The patient continued to present with severe disorientation, limited speech, and altered state of consciousness with occasional spastic-like movements. Antipsychotic and benzodiazepine medication was initiated, with no significant change in presentation. The patient continued to be witnessed wandering and having incoherent speech. First signs of improvement came 21 days postadmission with brief conversation and lucidity. This continued to improve over the next 7 days where he was reported to be at his baseline mental state. Environmental stressors including university examinations, the COVID-19 pandemic, and recent contact with his estranged father were possible precipitants to the episode. The patient reported almost complete unawareness of the psychiatric admission. A diagnosis of dissociative disorder, unspecified, was given. This case shows the management and diagnostic challenges of patients presenting with the aforementioned symptoms. There are no formal guidelines for the management of treating dissociative episodes, and this case report suggests the possible benefits of a drug-free period of watchful waiting upon admission.

World Mental Health Day 2018, but how aware are medical students?

With the recent global interest in mental health, there has been an increase in the number of people coming forward to discuss the once frowned upon illness. It is true that some progress has been made in terms of establishing an equal footing within the health and social care landscape with the help of various campaigns. However, there is still much work to be done with regards to removing the stigma of mental health within the healthcare sector itself. It is no surprise that mental illness statistics are significantly higher amongst medical practitioners due to the high-stress nature of their jobs, yet it is believed to be under reported. Interestingly, there is emerging evidence that physician burn out stems early in their careers whilst in medical school, suggesting areas that need improvement in medical education with regards to how medical students view and handle mental illness. As such, two issues have been identified and discussed here - the stigmatisation of mental illness whilst in medical school and the underemphasis of mental illness as compared to other physical health problems in medical education. It is hoped that discussing these issues can help stimulate subsequent positive changes.

Is Anatomy dead?

Anatomy is often said to be the bread and butter of doctors, but in light of the ever-increasing additions to medical curricula and difficulties in teaching the subject, Anatomy has dropped out of favour with both staff and students, making way for the teaching of other new exciting specialties. In this paper, we highlight some of the new advances Anatomy has made in the recent years, demonstrating the relevance and potential clinical implications these discoveries can have, thus supporting the notion that Anatomy as a subject is still very much alive and exciting, as it was in the early days

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Human Induced Pluripotent Stem Cells and the Modelling of Alzheimer's Disease: The Human Brain Outside the Dish.

BACKGROUND: Neurodegenerative diseases like Alzheimer's Disease (AD) are a global health issue primarily in the elderly. Although AD has been investigated using primary cultures, animal models and post-mortem human brain tissues, there are currently no effective treatments. SUMMARY: With the advent of induced pluripotent stem cells (iPSCs) reprogrammed from fully differentiated adult cells such as skin fibroblasts, newer opportunities have arisen to study the pathophysiology of many diseases in more depth. It is envisioned that iPSCs could be used as a powerful tool for neurodegenerative disease modelling and eventually be an unlimited source for cell replacement therapy. This paper provides an overview of; the contribution of iPSCs towards modeling and understanding AD pathogenesis, the novel human/mouse chimeric models in elucidating current AD pathogenesis hypotheses, the possible use of iPSCs in drug screening, and perspectives on possible future directions. KEY MESSAGES: Human/mouse chimeric models using iPSCs to study AD offer much promise in better replicating AD pathology and can be further exploited to elucidate disease pathogenesis with regards to the neuroinflammation hypothesis of AD.